The conclusion by Kirkland et al1 in their recent article that "In the southern United States, EM [erythema migrans]–like rash illness should no longer be considered definitive evidence of early Lyme disease" is both premature and unwarranted. As a clinician in Missouri who has identified, treated, followed up, reported, studied, presented, and published on these southern EM cases for a decade, I find this negative conclusion unsubstantiated by the authors' data. Proving a negative (null hypothesis) appropriately requires a high methodological standard, which was not met in the article by Kirkland et al.
Masters EJ. Erythema Migrans in the South. Arch Intern Med. 1998;158(19):2162-2164. doi: